Archive for 'thyroid'

My lipid panel indicated very low total cholesterol and even LDLs were lower than my cardiologist was happy with. At the time my Crestor intake of 20mg a day, coupled with 1 gram of Niaspan, and a strict diet and heavy exercise problem lead to these results.

The high reverse t3 levels (rt3) are a result of a restricted diet with over training. To verify there was no issue the reader will note in the results a lab draw on 10/12 that measured Iodine. The link discusses the relationship between Iodine and the thyroid gland.

Very low cholesterol has been tied to issues with memory loss and dementia, as well as other health issues. While many TRT specialists aim for a total cholesterol of 180 mg/dL I believe the body can function with lower levels. The thinking goes something like this. See the hormone tree below:

Note the cleaving enzyme that cleaves cholesterol into pregnenolone and then on down the steroid pathway. Without enough cholesterol there is not enough fuel for the remaining hormonal system, right? True – to a point.

The reality is everyone is different and that 180 mg/dL is not some magic number or target. For some, 120 may work fine, or even lower. The worry is that patients will remain non-compliant with cholesterol lowering medications without doctor supervision in an effort to “jump-start” their own testosterone or maximize hormone fuel by boosting cholesterol. The warning here is…be careful.

I lowered my dose to 5mg of cholesterol and purchased a cholesterol meter that measures Total Cholesterol, Triglycerides (TG), and HDL. This allows LDL to be calculated using the formula LDL Cholesterol = Total Cholesterol – HDL – (TG / 5). I ensure I am always above 120 and I am doing just fine. If I hit 180, I don’t panic. I get by without any problems with frequent exercise and some sanity in my diet.

Not shown in this lab that did show up on previous labs is an increase in hematocrit and RBC leading to polycythemia – an increase in red blood cell count per unit blood volume. This increases the risk of clot formation. If you have heart disease, watch out for this side effect. More often seen on shot therapy for TRT, it can happen even with gels. Treatment usually involves blood letting, a procedure that can be ordered by your doctor. Also, it helps to cease TRT treatment every 12-18 months for a short period of time.

As far as the testosterone levels go, I was on 1.5 tubes of Testim for this test, applied in the morning, and the blood work done 2 hours after application. My testosterone was screaming high at over 1400ng/dl. This level is a false reading as a future lab would indicate.

WARNING: Never apply Testim or any gel to the area where the blood draw will occur. This can taint the results. This is what happened for this particular test. I had to ignore the results.

First I must divorce any misconception this is the first flirtation with TRT. About 8 years ago, after taking the blood pressure medication Prinzide – a combination Thiazide diuretic/ACE inhibitor – I had a collapse after four days. Profound in nature, this event changed my life. From a strapping young man capable of 100 push-ups, I could not longer manage even 10. A visit to a local endocrinologist indicated all of my endocrine systems were compromised. Suddenly I was diabetic, I became seriously depressed, and all of my muscles experienced a weakness that was frightening. This included my diaphragm and I required a velcro weight belt to provide support and assist in relieving any weight on the diaphragm just so I could breathe.

I immediately began to treat the depression, and began an exercise program that consisted of 100 deep-knee bends, as many push-ups as I could handle, and walking for short distances. After the depression resolved itself, additional tests which indicated high cortisol and I barely passed a dexamethasone supression test. Failure of this test is indicative of adrenal issues. Measured testosterone was very low at 185 ng/dL. I decided to treat the testosterone only and attempted both Androgel and Testim, finally deciding on the Testim. I saw many specialists including a neurologist, a lung specialist, a neurosurgeon, and a cardiologist. After over fifty thousand dollars worth of tests they found….nothing wrong. MRIs, stress tests, multiple visits to my general practitioner and nothing, nada, zilch. I first suspected rhabdomyolysis, which testing quickly ruled out. MRIs of the pituitary, hypothalamus, and adrenals were negative. The only conclusion offered by one doctor – I suffered from a variant of Guillain-Barre syndrome, an ascending paralysis that in the worse cases becomes complete, with the patient on a ventilator. The disease usually resolves itself after a period of months, weeks, and sometimes years.

My decision to create a new section on this site specifically dedicated to Testosterone Replacement Therapy is two-fold. One, TRT has changed my life. With evidence that Testosterone acts very similar to a calcium channel blocker by dilating arteries, my decision to start TRT was not just related to low testosterone levels, but also to the benefits I perceived TRT possesses for heart health in individuals with heart disease. As a sufferer of heart disease and the recipient of 25 stents, I began my TRT with earnest. Secondly, TRT is not always beneficial unless the patient and the doctor understand just what is involved and what systems must be monitored to ensure success. It is my goal to ensure the reader is as educated on cutting edge replacement therapy.

TRT will not magically turn a diminishing libido into a raging storm of sexual passion, nor will it address erectile dysfunction issues in all cases when the only treatment involves measuring testosterone levels, choosing a treatment, and then walking out of the doctor’s office. Too many physicians have very little understanding of TRT, and many have no idea how to handle the tougher cases.

A lot has been happening and I know some of you are interested in my current status. As far as my latest testosterone measurements, taken 1 month after stopping the oral medications Clomid and Nolvadex, was 550 ng/dL. Not trusting this number and knowing that increases in my testosterone levels have been accompanied by increased liver enzymes in the past, I asked to be re-tested. However, a severe cold held off the latest blood test until yesterday. This time I am checking my testosterone, liver enzymes, kidney function, C-Reactive Protein, lipid profile, thyroid, vitamin-D, and a few other tests. I should have the results back in two weeks.

Meanwhile, next week on Friday I have a cardiac nuclear stress test. If I pass it, it will be 8 months since the placement of my last set of stents. My cardiologist is taking an 18 month sabattical and assisting a poor area in El Paso, TX to build a cardiology community.

For me, that meant going on a search for a new cardiologist. My previous cardiologist suggested one of his partners. This is my first option. My own research lead me to two well respected cardiologists in the Austin area. No surprisingly, they were unhappy with my number of stents, saying that most of them were probably not medically necessary. However, they both agreed that some cardiologists are more agressive than others with the use of stents.